Individual
OTTO LIEBMANN
Active
Individual
OTTO LIEBMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12526
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007059786
RI MEDICARE
RI
01
—
1/27/2009
TUFTS HEALTH PLAN
MA
01
—
1023039146
NPI
RI
01
—
12/13/2007
NHPRI
RI
05
—
2145464
—
MA
05
—
2145464
—
RI
01
—
414642
BCBSRI
RI
01
—
939025129
MEDICARE GROUP NUMBER
RI
01
—
P00671205
RAILROAD MEDICARE
—
Enumeration date
07/22/2006
Last updated
08/31/2020
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